Provider Demographics
NPI:1255648739
Name:WOJENSKI, SUSAN J (RDH)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:J
Last Name:WOJENSKI
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-4726
Mailing Address - Country:US
Mailing Address - Phone:860-276-0261
Mailing Address - Fax:
Practice Address - Street 1:19 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-4726
Practice Address - Country:US
Practice Address - Phone:860-276-0261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001889124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist